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Background: Very few studies have been conducted to establish the nature and prevalence of nail disorders in children. Objectives: To determine the frequency of various nail conditions in the paediatric setting and to report their management and follow-up. Methods: This was a retrospective study between 2007 and 2017 of children under 18. All the patients were evaluated in our paediatric nail clinic at the dermatology department of Queen Fabiola Children's University Hospital. The data were synthesized from information obtained through medical records as well as from photographs taken during consultation. Follow-up was completed by phone interview. Results: Three hundred and one patients were included. The majority of nail abnormalities involved the toenails (57.6%). The most common clinical signs were, in descending order, Beau's lines, pachyonychia, subungual hyperkeratosis and onycholysis. The most frequent diagnoses were fever-related Beau's lines or onychomadesis (9.7%), trachyonychia (8.4%), longitudinal melanonychia (8.1%) and congenital malalignment of the great toenail (8.1%). The main diagnoses by age group were as follows: congenital hypertrophy of the lateral nail folds (21.4%) [0–2 years old]; fever-related Beau's lines or onychomadesis (21%) [2–6 years old]; trachyonychia (22%) [6–12 years old]; and juvenile ingrown nail (21.4%) [12–18 years old]. Management included clinical observation for 119 patients and specific advices for 108 patients. A treatment was prescribed for 134 patients, topical in 76.5% of cases. Follow-up demonstrated complete healing in 50.6% of patients and improvement in 19.7%. Conclusion: The most frequent nail disorders are benign, and their distribution varies with age. Management mainly involves conservative care, and the prognosis is favourable in the majority., SCOPUS: ar.j, info:eu-repo/semantics/published

Background Nail abnormalities in childhood are generally uncommon. Recently, onychomadesis was described as a late complication of hand-foot-and-mouth disease (HFMD). Onychomadesis outbreaks following HFMD have been reported in many countries worldwide. Aim To present a case series of onychomadesis in children, following HFMD outbreak in Northern Greece, and review literature data. Methods Children with evident onychomadesis attending the outpatient clinic between November 2012 and January 2013 were included in the study. A questionnaire including demographic personal and family history information of the children was completed by the parents. Patients were clinically examined, and their pediatric and dermatological records were studied to confirm precedent HFMD. Direct microscopic examination and cultures for fungi were performed. Exposure of participants to coxsackievirus, based on serology testing during infection, was also recorded. Results Sixty-eight children with onychomadesis were included. The mean number of affected nails was 8.82. Fingernails were more often involved. Previous clinical diagnosis of HFMD was confirmed in 67/68 cases. The mean time from HFMD diagnosis to onychomadesis development was 39.6 days (range: 28–56 days, STD: 7.33). Direct microscopic examination, as well as cultures for fungal species, was negative for the whole sample size. All the nail changes were transient with spontaneous regrowth after 1–4 months. Conclusion Our data indicate that onychomadesis outbreak in the region of Thessaloniki during fall–winter 2012–13 was highly related to the outbreak of HFMD. Our study reinforces existing evidence for the association between onychomadesis and HFMD.

Symmetrical lupoid onychomadesis (SLO) is a disease not infrequently seen in bearded collie dogs in Germany.The aim of this study was to compare historical and clinical data, as well as the mineral content of the hair and claws of bearded collies with SLO with that of normal control dogs.Twenty-eight affected bearded collie dogs and 39 control dogs.Owners completed an extensive questionnaire regarding upbringing, environmental conditions and diets. Claw specimens were obtained by claw trimming or gathering lost claws; hairs were obtained by plucking samples from several areas of the body; samples were converted to ash and evaluated in an atomic absorption spectrophotometer.Clinical signs in affected dogs eventually involved all claws on all paws. In twelve dogs recurrence of onychomadesis was observed. There was no relevant association between gender, housing, diet and health management, physical stress and the development of SLO with exception of the age at which more intense exercise began. The most commonly used treatment combination was fatty acids, pentoxifylline and tetracycline; improvement occurred in 17 animals. Calcium, sodium and phosphorus concentrations were higher in the claws of affected dogs, whereas zinc concentrations were lower. The mineral content of hair samples of the affected dogs was not significantly different than controls.Symmetrical lupoid onychomadesis in bearded collies is clinically similar to what has been described in other breeds with regard to clinical signs and response to treatment. Early strenuous activity may increase the risk for disease occurrence in this breed.L'onychomadèse lupoïde symétrique (SLO) est une maladie rare chez le bearded collie en Allemagne.Le but de cette étude était de comparer les données cliniques et anamnestiques ainsi que le contenu minéral des poils et des griffes de bearded collie de Institute for Animal Nutrition and Dietetics/LMU Munich, atteints de SLO avec des chiens contrôles sains.Vingt huit bearded collie atteints et 39 chiens contrôles. MATÉRIELS ET MÉTHODES: Les propriétaires ont rempli un questionnaire complet concernant l’éducation, les conditions environnementales et les régimes alimentaires. Les échantillons de griffe ont été obtenus par coupe de griffe ou récupération de griffes perdues; les poils ont été obtenus par prélèvement de plusieurs régions du corps; des échantillons ont été convertis en cendres et évaluées dans un spectrophotomètre d'absorption atomique. RÉSULTATS: Les signes cliniques des chiens atteints pouvaient atteindre toutes les griffes de toutes les pattes. Pour douze chiens, une récidive d'onychomadèse était observée. Il n'y avait pas d'association significative entre genre, habitat, alimentation et entretien, stress physique et le développement de SLO à l'exception de l’âge auquel un exercice intense était initié. L'association de traitements la plus fréquemment utilisée était acides gras, pentoxifylline et tétracycline; l'amélioration était observée pour 17 animaux. Les concentrations de calcium, sodium et phosphore étaient plus élevées dans les griffes des chiens atteints tandis que les concentrations de zinc étaient plus faibles. Le contenu minéral des échantillons de poils des chiens atteints n’était pas significativement différent des chiens contrôles.L'onychomadèse lupoïde symétrique chez le bearded collie est cliniquement identique à celle décrite dans les autres races concernant les signes cliniques et les réponses aux traitements. Une activité intense précoce peut augmenter le risque d'apparition de la maladie dans cette race.INTRODUCCIÓN: la onicomadesis lupoidea simétrica (SLO) es una enfermedad que se ve con relativa frecuencia en perros Bearded Collie en Alemania. OBJETIVOS: el objetivo de este estudio fue comparar los datos históricos y clínicos, así como el contenido mineral del cabello y las uñas de Bearded Collies barbudos con SLO con el de perros control normales procedentes del Instituto de Nutrición Animal y Dietética/LMU Munich ANIMALES: veintiocho perros Bearded Collie afectados y 39 perros control. MÉTODOS Y MATERIALES: los propietarios completaron un extenso cuestionario sobre crecimiento, condiciones ambientales y dietas. Las muestras de uñas se obtuvieron cortándolas o recogiendo uñas perdidas; los pelos se obtuvieron arrancando muestras de varias áreas del cuerpo; las muestras se convirtieron en cenizas y se evaluaron en un espectrofotómetro de absorción atómica. RESULTADOS: los signos clínicos en los perros afectados finalmente afectaron todas las uñas en todas las extremidades. En doce perros se observó recurrencia de onicomadesis. No hubo una asociación relevante entre el género, la vivienda, la dieta y el manejo de la salud, el estrés físico y el desarrollo de SLO, con excepción de la edad en que comenzó el ejercicio más intenso. La combinación de tratamiento más utilizada fue ácidos grasos, pentoxifilina y tetraciclina; se observó mejoría en 17 animales. Las concentraciones de calcio, sodio y fósforo fueron mayores en las uñas de los perros afectados, mientras que las concentraciones de zinc fueron menores. El contenido mineral de las muestras de pelo de los perros afectados no fue significativamente diferente de los controles. CONCLUSIÓN E IMPORTANCIA CLÍNICA: la onicomadesis lupoidea simétrica en Bearded Collies barbudos es clínicamente similar a lo que se ha descrito en otras razas con respecto a los signos clínicos y la respuesta al tratamiento. La actividad vigorosa en edad temprana puede aumentar el riesgo de aparición de la enfermedad en esta raza.Die Symmetrische Lupoide Onychomadese (SLO) ist eine Erkrankung, die beim Bearded Collie in Deutschland nicht selten gesehen wird.Das Ziel dieser Studie war ein Vergleich der anamnestischen und klinischen Daten sowie des Mineralgehalts von Haaren und Krallen am Institut für Tierernährung und Diätetik/LMU München zwischen Bearded Collies mit SLO und normalen Kontrollhunden.Achtundzwanzig betroffene Bearded Collies und 39 Kontrollhunde.Die BesitzerInnen füllten einen ausführlichen Fragebogen in Bezug auf das Aufwachsen, die Umweltbedingungen und dem verabreichten Futter aus. Es wurden Krallenproben im Zuge des Krallenschneidens entnommen oder verlorene Krallen wurden eingesammelt; es wurden Haare durch Auszupfen an verschiedenen Stellen des Körpers entnommen; die Proben wurden in Asche umgewandelt und mittels Atomabsorptionsspektrometer evaluiert.Die klinischen Zeichen der betroffenen Hunde betrafen letztendlich alle Krallen an allen Pfoten. Bei zwölf Hunden wurde ein Wiederauftreten einer Onychomadese beobachtet. Es bestand kein relevanter Zusammenhang zwischen Geschlecht, Art des Wohnens, dem Futter und dem Gesundheitsmanagement, dem physischen Stress und der Entwicklung von SLO mit Ausnahme des Alters, ab welchem eine intensivere Bewegung begann. Die am häufigsten verwendete Kombinationstherapie bestand aus essentiellen Fettsäuren, Pentoxifyllin und Tetrazyklin; eine Verbesserung trat bei 17 Tieren auf. Kalzium, Natrium und Phosphor Konzentrationen waren in den Krallen betroffener Hunde höher, während die Zinkkonzentrationen niedriger waren. Der Mineralgehalt der Haarproben der betroffenen Hunde war von jenem der Kontrollhunde nicht signifikant verschieden.Die symmetrische lupoide Onychomadese beim Bearded Collie ist klinisch jener Erkrankung ähnlich, die bei anderen Rassen in Bezug auf klinische Zeichen und Behandlungserfolg beschrieben wurde. Eine sehr frühzeitige anstrengende Aktivität könnte das Risiko eines Auftretens der Erkrankung bei dieser Rasse fördern.背景: 対称性ループス状爪脱落症(SLO)は、ドイツのベアデッド・コリーにしばしば認める疾患である。 目的: 本研究の目的は、SLOのベアデッド・コリーの動物栄養食事療法学会/ LMUミュンヘンからの歴史的および臨床的データ、ならびに毛髪および爪のミネラル含有量を正常対照犬と比較することであった。 被験動物: 28頭の罹患ベアデッド・コリーと39頭の対照犬。 材料と方法: オーナーは、育て方、環境条件および食事療法に関して広範なアンケートに回答した。爪標本は、爪のトリミングまたは紛失した爪の収集によって得られた。体のいくつかの領域から抜毛することによって毛サンプルを得た。サンプルを灰に変換し、原子吸光分光光度計で評価した。 結果: 罹患犬の臨床徴候は結局四肢のすべての爪に伴った。 12頭の犬において爪脱落症の再発が観察された。より激しい運動が始まった年齢を除いて、性別、住居、食事および健康管理、身体的ストレスとSLO発症との間に関連性はなかった。最も一般的に使用されている治療の組み合わせは、脂肪酸、ペントキシフィリンおよびテトラサイクリンであった。17頭の動物で改善を認めた。カルシウム、ナトリウムおよびリン濃度は罹患犬の爪においてより高かったが、亜鉛濃度はより低かった。罹患犬の毛サンプルのミネラル含有量は、コントロール群とそれほど違いはなかった。 結論と臨床上の重要性: ベアデッド・コリーの対称性ループス状爪脱落症は、臨床的徴候および治療に対する反応に関して他品種に記載されているものと臨床的に類似している。早期の激しい活動は、この品種の疾患発生のリスクを高める可能性がある。.背景: 对称性狼疮样脱甲症(SLO)是一种在德国的长须牧羊犬中并非偶见的疾病。 目的: 本研究资料来自慕尼黑大学动物营养和饮食研究所,目的是比较患SLO的长须牧羊犬和对照犬的病史和临床症状,以及毛发和爪的矿物质含量。 动物: 二十八只患SLO的长须牧羊犬和三十九只对照犬。 方法和材料: 由主人填写关于抚养、环境条件和饮食的广泛调查问卷。通过修剪爪子或脱落的爪子获得爪样本; 从身体的多个部位采集毛发; 将样品转化为灰分,并在原子吸收分光光度计中测定。 结果: 患犬爪部的所有爪子最终都会有临床症状。十二只犬中出现了脱甲症的复发。除了早期更剧烈运动的年龄外,性别、饲养场所、饮食、健康管理、身体压力和SLO的发展之间没有关联。最常用的治疗组合是脂肪酸、己酮可可碱和四环素; 17只动物的临床症状得到了改善。患犬爪中的钙、钠和磷浓度较高,而锌浓度较低。患犬毛发样本的矿物质含量与对照无显着差异。 结论和临床价值: 在临床症状和治疗效果方面,长须牧羊犬的对称性狼疮样脱甲症与其他品种所描述的相似。早期剧烈活动可能会增加该品种的发病风险。.A onicomadese lupoide simétrica (SLO) é uma doença não raramente vista em bearded collies na Alemanha.O objetivo deste estudo foi comparar dados clínicos e de prontuários, bem como o conteúdo mineral dos pelos e uhas, entre bearded collies com SLO e cães normais controle, no Instituto de Nutrição Animal e Dietética/LMU Munique.Vinte e oito bearded collies afetados e 39 cães controle. MÉTODOS E MATERIAIS: Os proprietários preencheram um extenso questionário sobre educação, condições ambientais e dieta. Espécimens de unhas foram obtidos por corte de unhas ou coleta de unhas perdidas; os pelos foram obtidos por arrancamento de amostras de diversas áreas corpóreas; as amostras foram transformadas em cinzas e avaliadas em um espectrofotômetro de absorção atômica.Eventualmente, os cães afetados apresentavam envolvimento de todas as unhas em todas as patas. Em doze cães, observou-se recorrência da onicomadese. Não houve associação relevante entre gênero, habitação, dieta e rotina de saúde, estresse físico e o desenvolvimento de SLO, com exceção da idade em que o animal começou a praticar exercícios mais intensos. A associação de tratamentos mais utilizada foi ácidos graxos, pentoxifilina e tetraciclina; houve melhora em 17 animais. As concentrações de cálcio, sódio e fósforo foram maiores nas unhas dos animais afetados, enquanto as concentrações de zinco foram menores. Não houve diferença significativa entre o conteúdo mineral dos pelos dos animais afetados e controle. CONCLUSÕES E IMPORTÂNCIA CLÍNICA: Em relação aos sinais clínicos e resposta ao tratamento, a onicomadese lupoide simétrica em bearded collies é clinicamente similar ao que tem sido descrito em outras raças. A prática de atividades extenuantes precocemente pode aumentar o risco dessa doença em animais desta raça.

This report evaluates the June 2008 onychomadesis outbreak in Valencia, Spain. The study sample consisted of 221 onychomadesis cases and 77 nonaffected individuals who lived close to those affected. We collected data on dietary variables, hygiene products, and individual pathological histories. Feces and blood specimens were collected from 44 cases and 24 controls to evaluate exposure to infectious agents. Pathological background data revealed a high frequency (61%) of hand, foot, and mouth disease among the onychomadesis cases. Coxsackievirus A10 was the most commonly detected enterovirus in both case and control groups (49%). Other enteroviruses such as coxsackieviruses A5, A6, A16, B1, and B3; echoviruses 3, 4, and 9; and enterovirus 71 were present in low frequencies in the case and control groups (3-9%). The 2008 onychomadesis outbreak in the metropolitan area of Valencia was associated with an outbreak of hand, foot, and mouth disease primarily caused by coxsackievirus A10.

Background The frequency and types of nail changes in pemphigus vulgaris (PV) are unclear. Aim To determine the frequency and types of nail changes, and their correlation with the number of skin and periungual bullae. Methods Seventy-nine patients with PV, including 59 new patients and 20 patients in relapse, were entered into the study. Microscopic examination in potassium hydroxide and culture for fungus were performed on all clinically abnormal nails. Results Twenty-five (31.6%) of 79 patients showed nail changes, with paronychia (n = 8) and onychomadesis (n = 6) being the most common. One patient in relapse had onychomycosis. The frequency of nail changes in fingers affected by periungual bullae was significantly higher than in other fingers (P

Hydroxyurea is a chemotherapeutic agent used to treat hypereosinophilic syndrome, mast cell tumours and many myeloproliferative disorders. It is usually well tolerated; however, reported side effects include myelosuppression and gastrointestinal complications as well as cutaneous toxicity, in very rare cases. We report the unusual appearance of onychomadesis involving several claws on all feet in two canine patients receiving long-term hydroxyurea treatment. The healing of nail lesions required cessation of treatment in one dog and dose reduction in the second animal, supporting a strict relationship between onychopathy and administration of hydroxyurea. The aim of this case report is to increase clinical awareness of dermatological toxicity associated with long-term administration of hydroxyurea.

Yellow nail syndrome is an uncommon disorder characterized by dystrophic nails, lymphedema, and respiratory disease. It has rarely been reported in children and this is the first report of congenital yellow nails in siblings. The purpose of this study was to determine whether topical vitamin E applied to the nail plates and periungual skin would affect the growth rate or appearance of the fingernails in patients with congenital yellow nail syndrome. This study was the first trial of a treatment for this entity in children and the largest randomized double blind trial to date. We found that vitamin E solution had no significant effect (p = 0.84) on fingernail growth or the global appearance score (p = 1.0) when compared with placebo. The average growth rates and global assessment scores improved and onycholysis and onychomadesis decreased from baseline with both vitamin E and placebo treatment, although these were not primary end points of the study. Topical vitamin E did not result in a statistically significant improvement when compared with oil alone for the treatment of the nails in our three patients with yellow nail syndrome. However, it is interesting and perhaps clinically useful that both vitamin E and placebo oil improved the condition of the nails.

The purpose of this retrospective study was to evaluate the efficacy of various therapeutic options in dogs with lupoid onychodystrophy. The treatment records of 30 dogs with lupoid onychodystrophy diagnosed by clinical and histological changes at three institutions (Animal Skin and Allergy Clinic: Melbourne, Colorado State University and Denver Veterinary Specialists) were evaluated retrospectively. The response to various treatments was graded as excellent (normal claws), good (claws still dystrophic, but no associated clinical signs or onychomadesis), partial (still occasional onychomadesis) or poor (no change with treatment). Dogs were treated with either fatty acid supplementation (n = 17), doxycycline and niacinamide (n = 13), tetracycline and niacinamide (n = 10), pentoxifylline (n = 5), prednisolone (n = 4), azathioprine (n = 1) or clofazimine (n = 1) or with combinations thereof. Most dogs initially were treated with antibiotics typically effective against cutaneous pathogens, and in most dogs this led to partial improvement only. An excellent or good response was seen in approximately half of the patients treated with tetra- or doxycycline in combination with niacinamide. Six of the dogs were maintained successfully on fatty acid supplementation, two on pentoxifylline. An excellent response was seen in two of the three dogs treated exclusively with antibiotics. Spontaneous remissions and recurrences made evaluation of success rates difficult. A variety of medications may be useful in the treatment of lupoid onychodystrophy, although the high success rate of fatty acids previously reported could not be confirmed. The study emphasized the varied and often unclear aetiology and natural course of the syndrome. This study was supported financially by Colorado State University.

Hand-foot-mouth disease (HFMD) is a contagious enteroviral infection occurring primarily in children and characterized by a vesicular palmoplantar eruption and erosive stomatitis. Nail matrix arrest has been associated with a variety of drug exposures and systemic illnesses, including infections, and may result in a variety of changes, including transverse ridging (Beau's lines) and nail shedding (onychomadesis). The association of HFMD with Beau's lines and onychomadesis has not been reported previously. Five children, ages 22 months-4 years, presented with Beau's lines and/or onychomadesis following physician-diagnosed HFMD by 3-8 weeks. Three of the five patients experienced fever with HFMD, and none had a history of nail trauma, periungual dermatitis, periungual vesicular lesions, or a significant medication intake history. All patients experienced HFMD within 4 weeks of one another, and all resided in the suburbs of the Chicago metropolitan area. In all patients the nail changes were temporary with spontaneous normal regrowth. The mechanism of the nail matrix arrest is unclear, but the timing and geographic clustering of the patients suggests an epidemic caused by the same viral strain.

This paper describes five dogs with symmetrical onychomadesis and onychodystrophy. Two of the dogs were diagnosed by histopathologic examination as having symmetrical lupoid onychodystrophy. The dogs have been successfully treated with omega-3 and omega-6 fatty acids for 30–52 months.

We assessed the prevalence of nail abnormalities in 272 children with alopecia areata who were seen in our department during an eight-year period. Of these, 126(46%; 50 girls, 76 boys) had nail abnormalities that were related to alopecia areata. Nail pitting was detected in 92 patients, Including 37 with alopecia totalis or alopecia universalis. Three patients experienced an onychomadesis of all 20 nails during the acute onset of alopecia areata universalis. Thirty-two (11.7%) had nail thinning and severe nail plate surface abnormalities that were consistent with a diagnosis of trachyonychia.

Valproic acid (VPA) is frequently used as an antiepileptic drug. Several side effects are known. We report on a child with onychomadesis as a possible side-effect of treatment with VPA. Normal nail growth was observed after stopping VPA. The pathomechanism of onychomadesis due to VPA treatment remains unclear.

We describe a case of moderate hand–foot syndrome and nail toxicity simultaneously occurred in a 69-year-old man with advanced gastric cancer (cT4-N3-M1, G3) previously treated with numerous antineoplastic agents, including PELFw (5-fluorouracil, epidoxorubicin, leucovorin, and cisplatin) and taxoids. Due to a recalcitrant course, the above therapeutic agents were discontinued for 4 weeks and he was given solely capecitabine 1250 mg twice daily for 2 weeks at 3-weekly intervals. After the third course of chemotherapy he developed a moderate hand–foot syndrome, acute paronychia, exudative hyponychial dermatitis, multiple periungual pyogenic granuloma-like lesions, onychomadesis and onycholysis (Figures 1A,B and 2A,B). Figure 1 (A,B) Exudative hyponychial dermatitis with transparent nonviscous exudative discharge; hyperkeratosis, onycholysis, onychomadesis and periungual pyogenic granuloma-like lesions Figure 2 (A,B) Subungual hyperkeratosis, onycholysis, and Beau's lines; erythema and desquamation involving the hands Clinical examination revealed subungual hyperkeratosis, onycholysis, onychomadesis, acute paronychia and transparent malodorous, nonviscous, exudative discharge from toenails, especially upon squeezing. Slightly erythematous papular and vascular lesions (granuloma-like) in the proximal nail fold region of four of his toes and Beau's lines were also observed. Hypercurvature on the transverse axis of the nail plates was present, giving a pinched shape to the free edges. No other nail changes such as leukonychia or hyponychium hyperpigmentation were observed. Microbiological examination did not reveal bacterial infections, and repeated potassium hydroxide examinations of the nails did not show fungal hyphae. Treatment was initiated with soaking the nails with 0–5% potassium permanganate solution and application of gentamicin ointment. The hyponychial dermatitis and the above-described nail changes, including periungual pyogenic granuloma-like lesions, gradually resolved after the cessation of capecitabine for 8–12 weeks. The patient lost the nail of the great toes after about 3 weeks. Naranjo algorithm evaluation obtained a score of 9, which indicates a high probability that the adverse reaction was due to the drug [1]. Several chemotherapeutic agents, including taxoids, cyclophosphamide, doxorubicin/daunorubicin, 5-fluorouracil and vincristine, and combinations have been reported to induce nail and periungual changes: alterations may involve nail matrix (e.g. Beau's lines, onychomadesis, hyperpigmentation), nail bed (e.g. onycholysis, subungual haemorrhage, haematoma), and proximal nail fold (e.g. acute paronychia, periungual pyogenic granuloma) [2]. These adverse events are mostly mild to moderate in severity, but, if not properly managed, can result in significant pain and interfere with activities of daily living. Capecitabine (Xeloda®; Roche, Basel, Switzerland) is a fluoropyrimidine carbamate with antineoplastic activity. It is an orally administered systemic prodrug of 5′-deoxy-5-fluorouridine which is converted to 5-fluorouracil and preferentially activated at the tumour site. Fluoropyrimidine carbamate is a chemotherapeutic drug currently approved by the US Food Drug Administration for use as first-line therapy in patients with metastatic colorectal cancer or metastatic breast cancer. Capecitabine has also been used, alone or in different combinations, as a treatment of advanced gastric cancer, with interesting results [3, 4]. In clinical trials, the most frequent side-effects include gastrointestinal and haematological complications, hand–foot syndrome, hyperbilirubinaemia and anorexia. Although hand–foot syndrome is observed in up to 50% of patients treated with capecitabine, other mucocutaneous side-effects such as dermatitis, stomatitis, skin/nail discoloration and alopecia have been rarely reported [3, 4]. The incidence of nail changes is probably underestimated and still ill-defined; in particular, although the effects of taxoids [5] and epidermal growth factor receptor inhibitors (anti-EGFR agents) [6] are well described, there are, to our knowledge, only few reports of nail toxicity associated with capecitabine as monotherapy [7–9]. The aetiology of chemotherapy-induced nail changes is unclear; probably, immunosuppression and consequent colonization of the nail bed, change and disruption of the nail plate, subungual oedema with loss of adhesion between nail bed and nail plate and inflammatory and erosive processes may contribute to the development of nail and periungual abnormalities [7–10]. The nail toxicity seen in our patient was unique for the simultaneous occurrence of subungual hyperkeratosis, onycholysis, onychomadesis, paronychia, hyponychial dermatitis and periungual pyogenic granuloma-like lesions. As capecitabine is being increasingly used in the treatment of advanced breast and colorectal cancers as well as other solid cancers, clinicians should be aware of the novel clinical side-effects of this medication that could lead to substantial subjective toxicity, with impairment of quality of life and discontinuation of chemotherapy.

We describe a case of pemphigus foliaceus (PF) confined to the nails in a 3-year-old male Hungarian short-haired pointer. The dog was presented with multiple painful nails causing lameness. Various treatments (antibiotics, antiseptic lotions) were ineffective. The lesions were confined to the nails. Dermatological examination showed sub- or intraungueal pustules progressively causing onychomadesis. Examination of the inside of the nails revealed a yellowish malodorous material. Some nails exhibited onychoschizis and onychogryphosis. An erythematous perionyxis was observed around some nails. Cytology of this yellowish material showed nondegenerative neutrophils and numerous acidophilic acantholytic keratinocytes. Fungal and bacterial cultures performed from nails were negative. Histopathological examination of an entire nail revealed the presence of stratified pustules within the nails and under the nail. These pustules contained nondegenerative neutrophils, eosinophils and numerous acidophilic acantholytic keratinocytes. These lesions were compatible with pemphigus foliaceus. Prednisolone (1 mg/kg twice daily, orally) plus a dermocorticoid (clobetasol, twice daily) was prescribed for 1 month. Clinical improvement was observed. The same treatment was discontinued for another month. Then, the dosage of prednisolone was tapered to a 3-day regimen for 2 months with daily clobetasol applications. During the following 6 months, topical therapy was discontinued. Four relapses were observed within 4 years. This is the first report of a case of PF strictly confined to the nails. Funding: Self-funded.